Healthcare Provider Details

I. General information

NPI: 1023120433
Provider Name (Legal Business Name): YORDANKA K IVANOVA D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUSTAVE L LEVY PL BOX 1187
NEW YORK NY
10029-6500
US

IV. Provider business mailing address

8 LEGGETT RD
BRONXVILLE NY
10708-4914
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-7681
  • Fax: 212-996-9793
Mailing address:
  • Phone: 914-255-1999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number050297
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: